A 65-year-old woman comes to the physician because of a 3-month history of intermittent palpitations and shortness of breath. Cardiopulmonary examination shows no other abnormalities. An ECG shows an absence of P waves, an oscillating baseline, and irregular RR intervals at a rate of approximately 95 beats per minute. she is diagnosed with atrial fibrillation and started the appropirate drugs includes warfarin. In the follow up she did well with no complians till yesterday when she presented with sudden-onset right-side weakness and difficulty speaking. Her son adds that she started taking a new drug 2 weeks ago, but he does not remember its name. Physical examination shows right hemiplegia, right hemisensory loss, expressive aphasia, and right homonymous hemianopia. MRI of the head shows a left middle cerebral artery territory infarct. Transesophageal echocardiogram reveals a small thrombus in the left atrium. This patient most likely started taking which of the following drugs recently?

Question

A 65-year-old woman comes to the physician because of a 3-month history of intermittent palpitations and shortness of breath. Cardiopulmonary examination shows no other abnormalities. An ECG shows an absence of P waves, an oscillating baseline, and irregular RR intervals at a rate of approximately 95 beats per minute. she is diagnosed with atrial fibrillation and started the appropirate drugs includes warfarin. In the follow up she did well with no complians till yesterday when she presented with sudden-onset right-side weakness and difficulty speaking. Her son adds that she started taking a new drug 2 weeks ago, but he does not remember its name.  Physical examination shows right hemiplegia, right hemisensory loss, expressive aphasia, and right homonymous hemianopia.  MRI of the head shows a left middle cerebral artery territory infarct.  Transesophageal echocardiogram reveals a small thrombus in the left atrium.  This patient most likely started taking which of the following drugs recently?

Quizplus · Accepted Answer

Eductional Objective: St John's wort induces cytochrome P450 hepatic microsomal enzymes.  As a result, a wide variety of drugs that are metabolized by these enzymes, such as warfarin, will have lower plasma concentrations and decreased efficacy.

A 65-Year-Old Woman Comes to the Physician Because of a 3-Month